I’m a Caregiver

Cancer Care Among Older Adults

Older adults often face different needs when fighting cancer

It was not so long ago that an elderly person suffering from cancer would have received limited treatment and been sent home to die.

“The common thought used to be that it wasn’t worth treating cancer in older patients; that they’d lived their lives; they might be dying anyway; they couldn’t tolerate the treatment; the treatment might adversely affect their quality of life; or that they didn’t want to live with the side effects of treatment,” said Gary Shapiro, MD, chairman of the department of Oncology at Johns Hopkins Bayview and co-founder of its Geriatric Oncology Program.

That would not have been particularly good news to many older adults like Charlotte, an 82-year-old woman who five years ago was diagnosed with breast cancer. Today, after surgery and chemotherapy, she remains in remission and lives an active live that includes traveling, taking adult education courses, gardening and spending quality time with her children and grandchildren.

A Disease of Aging

Cancer can strike anyone at any age, but it is considered a disease of aging. Certain cancers, such as breast, colon, prostate, pancreatic, lung, bladder and stomach, are linked directly to aging. For lung cancer, for example, the average age of onset is 72; for colon cancer it’s 71; breast cancer is 68.

As a means to treating older people with cancer, geriatric oncology programs have sprung up around the country. These programs focus on the unique needs of older patients, and take into consideration their complex medical histories, numerous drugs they are likely to be taking, possible problems with cognitive dysfunction, and general loss of organ function that occurs naturally among older people. In addition, many of these people present with other medical conditions as well, such as heart disease or diabetes, and the cancer may impact these diseases, or conversely. All treatments have to be managed together, which is what a geriatric oncology team does.

At certain hospitals, a medical ethicist may also be on staff to handle the often complex questions older patients may face, such as when treatment is called for and when it may be best to hold off.

These programs also must look at older patients holistically. For example, a patient who is experiencing problems with her hands as a result of treatment may require a different type of support than a cane in order to get around.

Treating Older Adults

When it comes to treatment for cancer, older adults:

May be less tolerant of certain treatments

Have decreased reserve (i.e. a capacity to respond to disease and treatment)

Have other medical problems that need to be addressed

Have functional problems, such as memory loss or a problem with their Activities of Daily Living

May lack a support network

Additionally, medical professionals need to take into account an older person’s susceptibility to falling and breaking a hip, which can compromise cancer treatment. This may mean the need to prescribe physical therapy to increase strength and reduce risks with a patient who may become weaker as a result of treatment.

Similarly, nutrition may pose a problem when it comes to tolerating certain types of treatment. A dietitian may need to create a nutrition program to boost the patient’s health status prior to any intervention.

Finally, palliative treatment may also play a role. This too becomes part of the balancing act in treating an older person with cancer.

San Francisco Factoid

Named for a semaphore telegraph that once stood on its summit, Telegraph Hill has been the home of poor immigrants, inspired artists, and wealthy investors. Its stairways traverse some of the city’s most charming terrain, but if you’d prefer to skip the climb up the 284-foot hill, you can take a bus or taxi directly to Coit Tower and start the tour from there. Nearby, North Beach still pulses with its Italian-immigrant heritage and Beat movement history.

Take the F-line historic streetcar to the Embarcadero and Greenwich Street stop. Head west into (1) Levi Plaza, where this tour begins. The brick building complex bordering this quiet city refuge houses the headquarters for jeans-maker Levi Strauss & Co., which got its start in San Francisco in 1853 when Strauss sold canvas overalls to gold miners. Source: http://travel.nationalgeographic.com/travel/city-guides/san-francisco-walking-tour-3/